Chapter 64 · Practical algorithms
Drainage: choosing between a nephrostomy, stent, and catheter
| Situation | Method of choice |
|---|---|
| Lower tract obstruction without signs of urethral trauma | Foley catheter; early expert guidance for difficult access |
| Suspected urethral trauma | Retrograde urethrography; avoid repeated blind attempts; controlled access or cystostomy |
| Upper tract obstruction without infection | Stent or nephrostomy according to cause, anatomy, and availability |
| Upper tract obstruction with infection | Stent or percutaneous nephrostomy: whichever is faster and safer; effectiveness is comparable |
| Retrograde access impossible | Percutaneous nephrostomy |
| Malignant obstruction | Stent or nephrostomy according to the level of obstruction, prognosis, anatomy, and treatment goals |
| Postoperative leakage | Stent, nephrostomy, or drainage according to the site and volume of leakage |
| Long-term drainage | Individualized choice with a mandatory review, replacement, or removal date |